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Khosravi S, Mousavi-Fatemi K, Ebrahimi P, Barary M, sio TT, Pirzaman AT. B-cell acute lymphoblastic leukemia associated with hypereosinophilia: a case report and brief literature review. SAGE Open Med Case Rep 2024; 12:2050313X241229592. [PMID: 38304855 PMCID: PMC10832437 DOI: 10.1177/2050313x241229592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
Few cases of B-cell acute lymphoblastic leukemia (B-ALL)-eosinophilia (ALL-eo) association have been reported. The lack or absence of blasts in the peripheral blood smear (PBS) along with urticarial rash, fever, arthralgia, myalgia, sweating, and dyspnea are common features of this condition. Herein, we report a 16-year-old male patient admitted to the emergency department with urticaria and generalized itching. PBS was examined, and eosinophils (90%) were seen in different fields. However, blast cells were not seen in PBS. In a bone marrow examination, terminal deoxynucleotidyl transferase-positive and CD20-positive lymphoid blasts were reported along with eosinophilia. Eventually, the B-ALL diagnosis was confirmed for the patient, and he was started on the Berlin-Frankfurt-Münster chemotherapy regimen. The association of B-ALL with hypereosinophilia is a rare condition. We hope this case report and literature review can help clinicians to manage this rare condition properly.
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Affiliation(s)
- Sahar Khosravi
- HSCT and Cancer Research Center of Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Mousavi-Fatemi
- Department of Hematology, Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouyan Ebrahimi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Students’ Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Terence T. sio
- Department of Radiation Oncology, Mayo Clinic, Pheonix, AZ, USA
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Sreedharanunni S, Varma N, Sachdeva MUS, Naseem S, Malhotra P, Bansal D, Trehan A, Varma S. The Spectrum of Hypereosinophilia and Associated Clonal Disorders - A Real-World Data Based on Combined Retrospective and Prospective Analysis from a Tropical Setting. Mediterr J Hematol Infect Dis 2018; 10:e2018052. [PMID: 30210745 PMCID: PMC6131107 DOI: 10.4084/mjhid.2018.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/20/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine the frequency, etiological spectrum and treatment outcome of hypereosinophilia (HE) and hypereosinophilic syndromes (HES) in a tropical setting. METHODS A retrospective analysis of hospital data of five years (January 2009 to December 2013) and a comprehensive prospective evaluation of patients presenting with HE/HES over a period of 33 months (January 2014 to September 2016) was performed. RESULTS HE/HES was diagnosed in a total of 125 patients during the study period with an estimated prevalence of 0.5-1 case per 100,000 population in our hospital settings. 41 patients were excluded from the final analysis due to lack of sufficient data. Infections, especially helminths were the commonest cause (34%) followed by primary/clonal HE/HES (24%) and reactive HE/HES secondary to various clonal disorders (14.3%). A lymphocytic variant of HES and FIP1L1-PDGFRA positive HES were diagnosed in 3.6% each. Imatinib-responsive BCR-ABL1 negative HE/HES constitute 7.1% in our patients. None of the clinical or routine laboratory features including the age of patients, duration of HE, presence or absence of organomegaly, hemoglobin levels, eosinophil %, absolute eosinophil count, total leukocyte count, platelet counts, serum IgE levels or presence of myelofibrosis could predict or exclude malignancy in patients with HE/HES. The absence of blasts in peripheral blood or the absence of >5% blasts in bone marrow does not exclude primary/clonal HES. CONCLUSIONS An underlying malignancy (Primary HE/HES and neoplasms leading to reactive HES; 35.7%) is diagnosed with nearly equal frequency compared to infections (34.5%) in tropical settings. There are no hematological or serological parameters, which can reliably be used to exclude an underlying malignancy, necessitating a thorough follow-up and comprehensive work-up in patients with HE/HES.
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Affiliation(s)
- Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India - 160012
| | - Pankaj Malhotra
- Internal Medicine (Clinical Hematology), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
| | - Deepak Bansal
- Pediatrics (Hematology/oncology unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
| | - Amita Trehan
- Pediatrics (Hematology/oncology unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
| | - Subhash Varma
- Internal Medicine (Clinical Hematology), Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012
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Acute Lymphoblastic Leukemia with Hypereosinophilia in a Child: Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061169. [PMID: 29867057 PMCID: PMC6025476 DOI: 10.3390/ijerph15061169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 01/04/2023]
Abstract
Background: Hypereosinophilia in children can be primary or secondary. Numerous malignant diseases can cause hypereosinophilia, but it is seldom caused by acute lymphoblastic leukemia (ALL). In the event of protracted hypereosinophilia, it is extremely important to make a correct differential diagnosis. Case presentation: We present the case of an 11-year-old boy of Moroccan origin with ALL with hypereosinophilic onset (eosinophils in peripheral blood, 10,000/µL) in the absence of other signs of neoplastic disease, and compare this case with 61 similar cases in the literature. Following hospital admission, the patient initially presented with headache-caused nocturnal awakenings, evening fever, and cough, and he also lost approximately 7 kg in weight in a month not associated with sweating or itching. We first performed bone marrow aspiration, which showed an increase in eosinophils without cellular morphological abnormalities, and bone marrow immunophenotyping showed that 4.5% of cells had a phenotype compatible with lymphoid blasts. A lumbar puncture was negative. Given the poor marrow involvement, it was necessary to repeat a new bone marrow aspiration two days later, which showed an increase in blasts to 14%. A concomitant bone marrow biopsy showed an infiltration of blasts typical of B-cell ALL equal to 20–30% with associated hypereosinophilia. Cytogenetic analysis showed an hyperdiploid karyotype: 53–55, XY, +X, add(1)(q21q25), +4, +9, +10, +14, +2, +1, +21/46, XY. Conclusions: ALL is one of the possible causes of persistent hypereosinophilia. In patients with ALL and hypereosinophilia, peripheral hypereosinophilia can precede the appearance of blasts. Due to the negative prognosis and the increased risk of complications in these patients, bone marrow aspiration and biopsy are recommended if common causes of secondary hypereosinophilia are excluded.
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Uksal U, Ozturk P, Colgecen E, Taslidere N, Patiroglu T, Ozdemir MA, Torun YA, Borlu M. Dermatological Findings in Turkish Paediatric Haematology-Oncology Patients. Eurasian J Med 2016; 48:107-11. [PMID: 27551173 DOI: 10.5152/eurasianjmed.2015.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Diagnoses of skin, mucosae, hair and nail manifestations in malignant diseases are often challenging because of life-threatening drug reactions, opportunistic infections or skin involvement of primary processes. Description of morphology, configuration and distribution of lesions is important in order to differentiate the self-healing eruptions from serious side effects of chemotherapy. There are case reports from Turkey including dermatological manifestations of malignancies and case series in adult patients but there are no published large group studies assessing all manifestations in children. The aim of this study was to evaluate the morphological features of dermatological findings in children with haemato-oncological diseases. MATERIALS AND METHODS The study was performed at the Erciyes University, Faculty of Medicine Pediatric Hematology-Oncology Clinic, Turkey. Three dermatologists daily consulted all patients admitted to the clinic during a one-year period. RESULTS The study group comprised of 157 children (79 female/78 male) aged 1-16 years (mean 7.19±4.63). Detailed dermatological examinations were performed, including oral-genital mucosae, hair and nails. Thorough skin examination revealed that 70% of the patients exhibited at least one dermatological finding. Generalized xerosis and hyperpigmentation were the most common findings among patients undergoing chemotherapy (24.19%). Multiple nevi on at least 10 covered areas were very frequent among patients undergoing long-term chemotherapy (18.47%). Three were identified as dysplastic nevus, but malignant transformation was not observed during the one-year study period. CONCLUSION Regular dermatological consultation may help resolve the diagnostic and therapeutic problems in paediatric haemato-oncology clinics.
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Affiliation(s)
- Umit Uksal
- Clinic of Dermatology, Private Practice, İstanbul, Turkey
| | - Pinar Ozturk
- Clinic of Dermatology, Erdem Hospital, İstanbul, Turkey
| | - Emine Colgecen
- Department of Dermatology, Bozok University School of Medicine, Yozgat, Turkey
| | - Nazan Taslidere
- Clinic of Dermatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Turkan Patiroglu
- Division of Pediatric Hematology-Oncology, Departments of Pediatrics, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mehmet Akif Ozdemir
- Division of Pediatric Hematology-Oncology, Departments of Pediatrics, Erciyes University School of Medicine, Kayseri, Turkey
| | - Yasemin Altuner Torun
- Division of Pediatric Hematology-Oncology, Departments of Pediatrics, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Murat Borlu
- Department of Dermatology, Erciyes University School of Medicine, Kayseri, Turkey
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Kobayashi D, Kogawa K, Imai K, Tanaka T, Sada A, Nonoyama S. Hyper-eosinophilia in granular acute B-cell lymphoblastic leukemia with myeloid antigen expression. Pediatr Int 2012; 54:543-6. [PMID: 22830543 DOI: 10.1111/j.1442-200x.2011.03471.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute lymphoblastic leukemia with eosinophilia (ALLEo) is a rare but a distinctive clinical entity. Clinical features of idiopathic hyper-eosinophilic syndrome (HES) can be seen in patients with ALLEo. We report a 10-year-old girl, in whom HES was initially suspected but further investigation confirmed the diagnosis of acute B-cell lymphoblastic leukemia with myeloid antigen expression. Clinical response to chemotherapy was excellent with achievement of complete remission for 4 years. Serum interleukin-3 and -5 were elevated at presentation and normalized with disappearance of eosinophilia after induction therapy, supporting the reactive nature of eosinophilia in ALLEo. Hematologic malignancy should be considered in patients with hyper-eosinophilia, before attributing it to HES.
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Affiliation(s)
- Daisuke Kobayashi
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201-2119, USA.
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Rapanotti MC, Caruso R, Ammatuna E, Zaza S, Trotta L, Divona M, Cicconi L, Funaro D, Federici G, Amadori S, De Rossi G, Lo-Coco F. Molecular characterization of paediatric idiopathic hypereosinophilia. Br J Haematol 2010; 151:440-6. [DOI: 10.1111/j.1365-2141.2010.08394.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Linabery AM, Jurek AM, Duval S, Ross JA. The association between atopy and childhood/adolescent leukemia: a meta-analysis. Am J Epidemiol 2010; 171:749-64. [PMID: 20228139 DOI: 10.1093/aje/kwq004] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Atopic disease is hypothesized to be protective against several malignancies, including childhood/adolescent leukemia. To summarize the available epidemiologic evidence, the authors performed a meta-analysis of associations between atopy/allergies, asthma, eczema, hay fever, and hives and childhood/adolescent leukemia, acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML). They searched MEDLINE literature (1952-March 2009) and queried international experts to identify eligible studies. Ten case-control studies were included. Summary odds ratios and 95% confidence intervals were computed via random-effects models. Odds ratios for atopy/allergies were 1.42 (95% confidence interval (CI): 0.60, 3.35) for 3 studies of leukemia overall, 0.69 (95% CI: 0.54, 0.89) for 6 studies of ALL, and 0.87 (95% CI: 0.62, 1.22) for 2 studies of AML, with high levels of heterogeneity detected for leukemia overall and ALL. Inverse associations were observed for ALL and asthma (odds ratio (OR) = 0.79, 95% CI: 0.61, 1.02), eczema (OR = 0.74, 95% CI: 0.58, 0.96), and hay fever (OR = 0.55, 95% CI: 0.46, 0.66) examined separately. Odds ratios for ALL differed by study design, exposure data source, and latency period, indicating that these factors affect study results. These results should be interpreted cautiously given the modest number of studies, substantial heterogeneity, and potential exposure misclassification but are useful in designing future research.
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MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/immunology
- Case-Control Studies
- Child
- Child, Preschool
- Confidence Intervals
- Dermatitis, Atopic/epidemiology
- Dermatitis, Atopic/immunology
- Humans
- Hypersensitivity, Immediate/epidemiology
- Hypersensitivity, Immediate/immunology
- Incidence
- Infant
- Infant, Newborn
- Leukemia/epidemiology
- Leukemia/immunology
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/immunology
- Multivariate Analysis
- Odds Ratio
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Prevalence
- Research Design
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
- Urticaria/epidemiology
- Urticaria/immunology
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Affiliation(s)
- Amy M Linabery
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota 55455, USA
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